Fathers' mental health and child development: The predictive value of fathers' psychological distress during pregnancy for the social, emotional and behavioral development of their children
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Background: While the effect of mothers’ mental health on children’s development is well documented, studies of the predictive value of psychological distress in fathers for their children’s early psychosocial and behavioural development are still scarce. Most studies in this field have investigated the effect of fathers’ postnatal depression on children’s development. Two longitudinal population cohort studies on the predictive value of fathers’ mental health during pregnancy for early child development found an association between expectant fathers’ psychological distress and their children’s development. However, further investigation of this association is warranted. Objectives: The overall aim of this thesis was to investigate if and to what extent expectant fathers’ mental health presents a risk factor for their children’s development. Paper I: To examine the association between symptoms of psychological distress in expectant fathers and the social, emotional and behavioural outcomes in their children at 36 months old and, given the existence of such an association, to assess the strength of this association of psychological distress in fathers with subsequent developmental difficulties in their children. Paper II: To investigate whether high levels of psychological distress in expectant parents are a risk factor for their children’s development and to evaluate the predictive value of high level of psychological distress during pregnancy in fathers, mothers and both parents for their children’s development. Paper III: To assess the prevalence of physically aggressive behaviour, defined as hitting others, in a large preschool-age child population and to investigate the association between expectant fathers’ psychological distress and children’s physically aggressive behaviour at 5 years old. In all three studies, the associations between psychological distress in fathers and children’s development were controlled for a large number of potentially confounding factors. Methods: This study was based on data from 31,663 children participating in the Norwegian Mother and Child Cohort Study (MoBa) (Magnus et al., 2006). Data on fathers’ and mothers’ prenatal psychological distress were obtained through the self-report Symptom Checklist-5 (SCL-5) at week 17 or 18 of gestation. Information on children’s social, emotional and behavioural development was obtained from mothers’ reports, using selected parts of the Strengths and Difficulties Questionnaire (SDQ), Infant and Toddler Social and Emotional Assessment (ITSEA) and Child Behavioural Checklist Revised (CBCL-R) (Achenbach & Ruffle, 2000; Carter, Brigg-Growan, Jones, & Little, 2003; R. Goodman, 1997, 2001). Linear and logistic regression analyses were performed to assess the predictive value of fathers’ psychological distress for their children’s subsequent development. Results: Of the fathers, 3% had high levels of psychological distress, defined as scoring higher than 2.00 on the SCL-5. We found small but consistent associations between fathers’ psychological distress and children’s behavioural difficulties, emotional difficulties and social functioning. In addition, a high level of psychological distress in fathers was associated with an almost doubled odds ratio (OR) for emotional difficulties in their children at 36 months old. The frequency of a high level of psychological distress in both mothers and fathers in this sample of expectant parents was 3.6%. When one or both parents reported a high level of psychological distress during pregnancy, the OR for emotional problems in their children at age 3 was significantly higher than among children whose parents did not report a high level of psychological distress during pregnancy. The risk of emotional difficulties in the child was higher when only the mothers reported a high level of psychological distress than when only fathers reported an elevated level of distress. The risk of emotional difficulties for children was highest when both parents presented high levels of psychological distress, indicating an additive effect from parents’ psychological distress on their children’s development.Earlier research findings reported that persistent physically aggressive behaviour from early childhood on is a risk factor for poor social adaption throughout childhood and adolescence. In this sample, 16% of the children still displayed physically aggressive behaviour (hitting others) at age 5. Boys hit others significantly more often compared to girls at 18 months old and at 3 years old but not at age 5. Children of fathers with high levels of psychological distress, as measured by the SCL-5, had an increased risk of hitting others at age 5. However, when the sample was stratified for gender, this effect of expectant fathers’ high level of psychological distress on hitting was found in girls but not in boys. Conclusions: There are small but consistent associations between expectant fathers’ psychological distress and subsequent social, emotional and behavioural developmental problems in their children. The findings of this study suggest that an increased risk of future developmental problems can be identified during pregnancy. Additionally, the results indicate that parents’ psychological distress has an additive effect on their children’s development: When high levels of psychological distress were observed in both parents, the OR for developmental problems in their children was higher than when only one parent suffered from such distress. The population-based study adds knowledge to the field of early onset behavioural difficulties in childhood, with the findings that approximately 16% of the preschool-aged children in the population-based sample still performed physically aggressive behaviour (hitting) in their interactions with others and that psychological distress in fathers was a risk factor for physically aggressive behaviour in their 5-year-old daughters. Based on earlier studies, the finding that fathers’ psychological distress was a risk factor for hitting behaviour in only girls was unexpected. Further studies are needed to explore these gender differences in physically aggressive behaviour, along with fathers’ psychological distress as a risk factor in their children’s behavioural difficulties.
Består avPaper I: Kvalevaag, A. L., Ramchandani, P. G., Hove, O., Assmus, J., Eberhard-Gran, M., & Biringer, E. (2013). Paternal mental health and socio-emotional and behavioural development in their children. Pediatrics, 131(2), e463–9. Full-text not available in BORA. The published version is available at: http://dx.doi.org/10.1542/peds.2012-0804
Paper II: Kvalevaag, A. L., Ramchandani, P. G., Hove, O., Eberhard-Gran, M., Assmus, J., Havik, O. E., Sivertsen, B., & Biringer, E. (Submitted 2014). Parents’ prenatal mental health and social, emotional and behavioural development in their children. The article is available here: http://hdl.handle.net/1956/9111
Paper III: Kvalevaag, A. L., Ramchandani, P. G., Hove, O., Eberhard-Gran, M., Assmus, J., Havik, O. E., Sivertsen, B., & Biringer, E. (Submitted 2014). Does paternal mental health in pregnancy predict physically aggressive behaviour in their children? . The article is available here: http://hdl.handle.net/1956/9116